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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000574

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of AmbroseMoquet Sex Male

Date of Birth May 28, 1921 Place of Birth Reserve MinesCounty of Cape Breton

Name of Father Lucien Moquet MAIDEN NAME of Mother Virginia Falndarie

Were the Parents married at the time of the Birth? Yes

Residence of Father when child was born Reserve Mines Present address of Father deceaed

Occupation of Father at Birth of child Peddlar Place of birth of Father France

Race Name and present address of Physician in attendance at birth

Signature of Applicant Ambrose Moquet Address of Applicant 244 Richard Clark Dr. Downsview, Ontario Date November 14, 1974

Relationship of Applicant to child Same

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of AmbroseMoquet

Born at Reserve Mines in the County of Cape Breton

That AmbroseMoquet Whose Birth is sought to be registered was

born at Reserve Mines Cape Breton County on May 28, 1921

My knowledge of the fact and date of such Birth is based on the following Circumstances:

As disclosed by a Certificate of Baptism

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